Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-29T17:03:47.388Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment Considerations for Anxiety in the Elderly

Published online by Cambridge University Press:  07 November 2014

Eric J. Lenze ,
Bruce G. Pollock ,
M. Katherine Shear ,
Benoit H. Mulsant ,
Ashok Bharucha  and
Charles F. Reynolds III
Get access Rights & Permissions [Opens in a new window]

Abstract

Anxiety is common in the elderly and can present as a primary anxiety disorder or as a symptom of another disorder. Generalized anxiety disorder, in particular, is a common syndrome in late life. Anxiety symptoms are also common features of late-life depression and dementia. Treatment of anxiety in elderly persons has typically involved the use of benzodiazepines, which are often effective but problematic because they are associated with increased risk of cognitive impairment, falls, and fractures. Based on their safety and efficacy, antidepressants, particularly serotonergic medications, are considered first-line treatment for most anxiety disorders as well as anxiety symptoms of major depressive disorder. Psychotherapy, particularly cognitive-behavioral therapy, may be effective in these disorders as well; research is underway to adapt this therapy to the needs of elderly persons. Anxiety symptoms in dementia are poorly understood but may respond to atypical antipsychotics, serotonergic antidepressants, or mood stabilizers. Overall, the research in late-life anxiety has not caught up to the literature in late-life depression and, for the most part, treatment recommendations must be extrapolated from studies in young adults.

Type
Academic Supplement
Information
CNS Spectrums , Volume 8 , Issue S3: Anxiety and Depression in the Elderly: Implications for Diagnosis and Treatment , December 2003 , pp. 6 - 13
Copyright
Copyright © Cambridge University Press 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.de Beurs, E, Beekman, A, Geerlings, S, Deeg, D, Van Dyck, R, van Tilburg, W. On becoming depressed or anxious in late life: similar vulnerability factors but different effects of stressful life events. Br J Psychiatry. 2001;179:426–431.CrossRefGoogle Scholar
2.Herman, JS, Rollman, BL, Hanusa, BH, Lenze, EJ, Shear, MK. Physician office visits of adults for anxiety disorders in the United States: 1985-1998. J Gen Intern Med. 2002;17:165–172.CrossRefGoogle Scholar
3.Gleason, PP, Schulz, R, Smith, NL, et al.Correlates and prevalence of benzodiazepine use in community-dwelling elderly. J Gen Intern Med. 1998;13:243–250.CrossRefGoogle ScholarPubMed
4.van Balkom, AJ, Beekman, AT, de Beurs, E, Deeg, DJ, Van Dyck, R, van Tilburg, W. Comorbidity of the anxiety disorders in a community-based older population in The Netherlands. Acta Psychiatr Scand. 2000;101:37–45.CrossRefGoogle Scholar
5.Wang, PS, Bohn, RL, Glynn, RJ, Mogun, H, Avorn, J. Hazardous benzodiazepine regimens in the elderly: effects of half-life, dosage, and duration on risk of hip fracture. Am J Psychiatry. 2001;158:892–898.CrossRefGoogle ScholarPubMed
6.Cumming, R, Le Couteur, D. Benzodiazepines and risk of hip fractures in older people: a review of the evidence. CNS Drugs. 2003;17;825–837.CrossRefGoogle ScholarPubMed
7.Pomara, N, Tun, H, DaSilva, D, Hernando, R, Deptula, D, Greenblatt, DJ. The acute and chronic performance effects of alprazolam and lorazepam in the elderly: relationship to duration of treatment and self-rated sedation. Psychopharmacol Bull. 1998;34:139–153.Google ScholarPubMed
8.Pomara, N, Deptula, D, Medel, M, Block, RI, Greenblatt, DJ. Effects of diazepam on recall memory: relationship to aging, dose, and duration of treatment. Psychopharmacol Bull. 1989;25:144–148.Google ScholarPubMed
9.Hanlon, JT, Horner, RD, Schmader, KE, et al.Benzodiazepine use and cognitive function among community-dwelling elderly. Clin Pharmacol Ther. 1998;64:684–692.CrossRefGoogle ScholarPubMed
10.Paterniti, S, Dufouil, C, Alperovitch, A. Long-term benzodiazepine use and cognitive decline in the elderly: The epidemiology of vascular aging study. J Clin Psychopharmacol. 2002;22:285–293.CrossRefGoogle ScholarPubMed
11.Beekman, AT, Bremmer, MA, Deeg, DJ, et al.Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam. Int J Geriatr Psychiatry. 1998;13:717–726.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
12.Manela, M, Katona, C, Livingston, G. How common are the anxiety disorders in old age? Int J Geriatr Psychiatry. 1996;11:65–70.3.0.CO;2-M>CrossRefGoogle Scholar
13.Lindesay, J, Briggs, K, Murphy, E. The Guy's/Age Concern survey. Prevalence rates of cognitive impairment, depression and anxiety in an urban elderly community. Br J Psychiatry. 1989;155:317–329.CrossRefGoogle Scholar
14.Uhlenhuth, EH, Balter, MB, Mellinger, GD, Cisin, IH, Clinthorne, J. Symptom checklist syndromes in the general population. Correlations with psychotherapeutic drug use. Arch Gen Psychiatry. 1983;40:1167–1173.CrossRefGoogle ScholarPubMed
15.Carter, RM, Wittchen, HU, Pfister, H, Kessler, RC. One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety diorder in a nationally representative sample. Depress Anxiety. 2001;13:78–88.CrossRefGoogle Scholar
16.Xavier, FM, Ferraz, MP, Trenti, CM, et al.Generalized anxiety disorder in a population aged 80 years and older. Rev Saude Publica. 2001;35:294–302.CrossRefGoogle Scholar
17.Blazer, D. The epidemiology of anxiety disorders: An age comparison. In: Salzman, C, Lebowitz, B, eds. Anxiety in the Elderly. New York, NY: Springer Publishing Co.; 1991:17–30.Google Scholar
18.Mohlman, J, Gorenstein, EE, Kleber, M, de Jesus, M, Gorman, JM, Papp, LA. Standard and enhanced cognitive-behavioral therapy for late-life generalized anxiety disorder. Am J Geriatr Psychiatry. 2003;11:24–32.Google ScholarPubMed
19.Stanley, MA, Beck, JG, Novy, DM, et al.Cognitive-behavioral treatment of late-life generalized anxiety disorder. J Consult Clin Psychol. 2003;71:309–319.CrossRefGoogle ScholarPubMed
20.Koepke, HH, Gold, RL, Linden, ME, Lion, JR, Rickels, K. Multicenter controlled study of oxazepam in anxious elderly outpatients. Psychosomatics. 1982;23:641–645.CrossRefGoogle ScholarPubMed
21.Bresolin, N, Monza, G, Scarpini, E, et al.Treatment of anxiety with ketazolam in elderly patients. Clin Ther. 1988;10:536–542.Google ScholarPubMed
22.Frattola, L, Piolti, R, Bassi, S, Albizzati, MG, et al.Effects of alpidem in anxious elderly outpatients: A double-blind, placebo-controlled trial. Clin Neuropharmacol. 1992;15:477–487.CrossRefGoogle ScholarPubMed
23.Small, GW, Bystritsky, A. Double-blind, placebo-controlled trial of two doses of abecarnil for geriatric anxiety. J Clin Psychiatry. 1997;58:24–29.Google ScholarPubMed
24.Stanley, MA. Treatment of generalized anxiety in older adults: A preliminary comparison of cognitive-behavioral and supportive approaches. Behav Ther. 1996;27:565–581.CrossRefGoogle Scholar
25.Stanley, MA, Hopko, DR, Diefenbach, GJ, Bourland, SL, Rodriguez, H, Wagener, P. Cognitive-behavioral therapy for late-life generalized anxiety disorder in primary care: Priliminary findings. Am J Geriatr Psychiatry. 2003;11:92–96.Google Scholar
26.Wetherell, JL, Gatz, M. Treatment of generalized anxiety disorder in older adults. J Consult Clin Psychology. 2003;71:31–40.CrossRefGoogle ScholarPubMed
27.Hemmelgarn, B, Suissa, S, Huang, A, Boivin, J-F, Pinard, G. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA. 1997;278:27–31.CrossRefGoogle ScholarPubMed
28.Herings, RMC, Stricker, BHC, deBoer, A, Bakker, A, Sturmans, F. Benzodiazepines and the risk of falling leading to femur fractures. Arch Intern Med. 1995;155:1801–1807.CrossRefGoogle ScholarPubMed
29.Liu, BA, Topper, AK, Reeves, RA, Gryfe, C, Maki, BE. Falls among older people: relationship to medication use and orthostatic hypotension. J Am Geriatr Soc. 1995;43:1141–1145.CrossRefGoogle ScholarPubMed
30.Ray, WA, Griffin, MR, Downey, W. Benzodiazepines of long and short elimination half-life and the risk of hip fracture. JAMA. 1989;262:3303–3307.CrossRefGoogle ScholarPubMed
31.Salzman, C, Fisher, J, Nobel, K, Glassman, R, Wolfson, A, Kelley, M. Cognitive improvement following benzodiazepine discontinuation in elderly nursing home residents. Int J Geriatr Psychiatry. 1992;7:89–93.CrossRefGoogle Scholar
32.Salzman, C. Anxiety in the elderly: treatment strategies. J Clin Psychiatry. 1999;51:18–21.Google Scholar
33.Dada, F, Sethi, S, Grosberg, GT. Generalized anxiety disorder in the elderly. Psychiatr Clin North Am. 2001;1:164.Google Scholar
34.Pollock, B, Mulsant, BH. Psychopharmacology. In: Crome, P, Ford, G, eds. Drugs and the Older Population. London, England: Imperial College Press; 2000:275–303.CrossRefGoogle Scholar
35.Katz, IR, Reynolds, CF, Alexopoulos, GS, Hackett, D. Venlafaxine ER as a treatment for generalized anxiety disorder in older adults: pooled analysis of five randomized placebo-controlled clinical trials. J Am Geriatr Soc. 2002;50:18–24.CrossRefGoogle Scholar
36.Manela, M, Katona, C, Livingston, G. How common are the anxiety disorders in old age? Int J Geriatr Psychiatry. 1996;11:65–70.3.0.CO;2-M>CrossRefGoogle Scholar
37.Regier, DA, Boyd, JH, Burke, JD, et al.One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Arch Gen Psychiatry. 1988;45:977–986.CrossRefGoogle ScholarPubMed
38.Beekman, A, Bremmer, MA, Deeg, Det al.Anxiety disorders in later life: A report from the Longitudinal Aging Study Amsterdam. Int J Geriatr Psychiatry. 1998;13:717–726.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
39.Flint, AJ, Cook, JM, Rabins, PV. Why is panic disorder less frequent in late life? Am J Geriatr Psychiatry. 1996;4:96–109.CrossRefGoogle ScholarPubMed
40.Flint, AJ, Koszycki, D, Vaccarino, FJ, Cadieux, A, Boulenger, JP, Bradwejn, J. Effect of aging on cholecystokinin-induced panic. Am J Psychiatry. 1998;155:283–285.CrossRefGoogle ScholarPubMed
41.Lenze, EJ, Mulsant, BH, Shear, MKet al.Comorbid anxiety disorders in depressed elderly patients. Am J Psychiatry. 2000;157:722–728.CrossRefGoogle ScholarPubMed
42.Brown, C, Schulberg, HC, Madonia, M, Shear, MK, Houck, P. Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders. Am J Psychiatry. 1996;153:1293–1300.Google ScholarPubMed
43.Palmer, BW, Jeste, DV, Sheikh, JI. Anxiety disorders in the elderly: DSM-IV and other barriers to diagnosis and treatment. J Affect Disord. 1997;46:183–190.CrossRefGoogle ScholarPubMed
44.Davidson, JR, Hughes, D, Blazer, DG, George, LK. Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med. 1991;21:713–721.CrossRefGoogle ScholarPubMed
45.Goenjian, AK, Najarian, LM, Pynoos, RSet al.Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia. Am J Psychiatry. 1994;151:895–901.Google ScholarPubMed
46.Madakasira, S, O'Brien, KF. Acute posttraumatic stress disorder in victims of a natural disaster. J Nerv Ment Dis. 1987;175:286–290.CrossRefGoogle ScholarPubMed
47.Sembi, S, Tarrier, N, O'Neill, P, Burns, A, Faragher, B. Does posttraumatic stress disorder occur after stroke: a preliminary study. Int J Geriatr Psychiatry. 1998;13:315–322.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
48.Dew, MA, Roth, LH, Schulberg, HC, et al.Prevalence and predictors of depression and anxiety-related disorders during the year after heart transplantation. Gen Hosp Psychiatry. 1996;18(suppl):48S–61S.CrossRefGoogle ScholarPubMed
49.Flint, AJ. Management of anxiety in late life. J Geriatr Psychiatry Neurol. 1998;11:194–200.CrossRefGoogle ScholarPubMed
50.Wylie, ME, Miller, MD, Shear, MK, et al.Fluvoxamine pharmacotherapy of anxiety disorders in later life: Preliminary open-trial data and a review of the literature. J Geriatr Psychiatry Neurol. 2000;13:43–48.CrossRefGoogle Scholar
51.Lenze, EJ, Fabian, T, Kroboth, P, et al.Treatment of anxiety disorders in elderly subjects: a controlled study with citalopram. Poster presented at: Annual Meeting of the International College of Geriatric Psychopharmacology; December 2003; San Juan, Puerto Rico.Google Scholar
52.Bohm, C, Robinson, DS, Gammans, REet al.Buspirone therapy in anxious elderly patients: a controlled clinical trial. J Clin Psychopharmacol. 1990;10:(suppl):S51.CrossRefGoogle ScholarPubMed
53.Barrowclough, C, King, P, Colville, J, Russell, E, Burns, A, Tarrier, N. A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. J Consult Clin Psychology. 2001;69:756–762.CrossRefGoogle ScholarPubMed
54.Goodnick, PJ, Puig, A, DeVane, CL, Freund, BV. Mirtazapine in major depression with comorbid generalized anxiety disorder. J Clin Psychiatry. 1999;60:446–448.CrossRefGoogle ScholarPubMed
55.Ribeiro, L, Busnello, JV, Kauer-Sant'Anna, M, et al.Mirtazapine versus fluoxetine in the treatment of panic disorder. Braz J Med Biol Res. 2001;34:1303–1307.CrossRefGoogle ScholarPubMed
56.Pande, AC, Pollack, MH, Crockatt, J, et al.Placebo-controlled study of gabapentin treatment of panic disorder. J Clin Psychopharmacol. 2000;20:467–471.CrossRefGoogle ScholarPubMed
57.Butterfield, MI, Becker, ME, Connor, KM. Olanzapine in the treatment of post-traumatic stress disorder: A pilot study. Clin Psychopharmacol. 2001;16:203.Google ScholarPubMed
58.Kaplan, M. Atypical antipsychotics for treatment of mixed depression and anxiety. J Clin Psychiatry. 2000;61:389.CrossRefGoogle ScholarPubMed
59.Bartels, SJ, Coakley, E, Oxman, TE, et al.Suicidal and death ideation in older primary care patients with depression, anxiety and at-risk alcohol use. Am J Geriatr Psychiatry. 2002;10:417–427.CrossRefGoogle ScholarPubMed
60.Beekman, AT, de Beurs, E, van Balkom, AJ, Deeg, DJ, Van Dyck, R, van Tilburg, W. Anxiety and depression in later life: co-occurrence and communality of risk factors. Am J Psychiatry. 2000;157:89–95.CrossRefGoogle ScholarPubMed
61.Mulsant, BH, Reynolds, CF, Shear, MK, Sweet, RA, Miller, MD. Comorbid anxiety disorders in late-life depression. Anxiety. 1996;2:242–247.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
62.Allgulander, C, Lavori, PW. Causes of death among 936 elderly patients with ‘pure’ anxiety neurosis in Stockholm County, Sweden, and in patients with depressive neurosis or both diagnoses. Compr Psychiatry. 1993;34:299–302.CrossRefGoogle ScholarPubMed
63.Flint, AJ, Rifat, SL. Anxious depression in elderly patients. Response to antidepressant treatment. Am J Geriatr Psychiatry. 1997;5:107–115.Google ScholarPubMed
64.Dew, MA, Reynolds, CF, Houck, PR, et al.Temporal profiles of the course of depression during treatment: predictors of pathways toward recovery in the elderly. Arch Gen Psychiatry. 1997;54:1016–1024.CrossRefGoogle ScholarPubMed
65.Lenze, EJ, Mulsant, BH, Shear, MK, Houck, P, Reynolds, CF. Anxiety symptoms in elderly patients with depression: What is the best approach to treatment? Drugs Aging. 2002;19:753–760.CrossRefGoogle ScholarPubMed
66.Lenze, EJ, Mulsant, BH, Dew, MA, et al.Good treatment outcomes in late-life depression with comorbid anxiety. J Affect Disord. In press.Google Scholar
67.Buysse, DJ, Reynolds, CF, Houck, PR, et al.Does lorazepam impair the antidepressant response to nortriptyline and psychotherapy? J Clin Psychiatry. 1997;58:426–432.CrossRefGoogle ScholarPubMed
68.Joo, JH, Lenze, EJ, Mulsant, BH, et al.Risk factors for falls during treatment of late-life depression. J Clin Psychiatry. 2002;63:936–941.CrossRefGoogle ScholarPubMed
69.Small, GW. Recognizing and treating anxiety in the elderly. J Clin Psychiatry. 1997;58:41–47.Google ScholarPubMed
70.Kim, JM, Lyons, D, Shin, IS, Yoon, JS. Differences in the behavioral and psychological symptoms between Alzheimer's disease and vascular dementia: are the different pharmacologic treatment strategies justifiable? Hum Psychopharmacol. 2003;18:215–220.CrossRefGoogle ScholarPubMed
71.Mintzer, J, Faison, W, Street, JS, Sutton, VK, Breier, A. Olanzapine in the treatment of anxiety symptoms due to Alzheimer's disease: A post-hoc analysis. Int J Geriatr Psychiatry. 2001;16(suppl):S71–S77.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
72.Cummings, JL. Use of cholinesterase inhibitors in clinical practice: evidence-based recommendations. Am J Geriatr Psychiatry. 2003;11:131–145.CrossRefGoogle ScholarPubMed
73.Covington, JS. Alleviating agitation, apprehension, and related symptoms in geriatric patients: a double-blind comparison of a phenothiazine and a benzodiazepine. South Med J. 1975;68:719–724.CrossRefGoogle Scholar
74.Hughes, CM, Lapane, KL, Mor, V, et al.The impact of legislation on psychotropic drug use in nursing homes: a cross-national perspective. J Am Geriatr Soc. 2000;48:931–937.CrossRefGoogle ScholarPubMed
75.Miller, MD, Frank, E, Reynolds, CF. The art of clinical management in pharmacologic trials with depressed elderly patients: Lessons from the Pittsburgh study of maintenance therapies in late-life depression. Am J Geriatr Psychiatry. 1999;7:228–234.CrossRefGoogle ScholarPubMed